Commonwealth Fund - 2004 Annual Report

Contains mission statement, president's message, program summaries, executive vice president's report, treasurer's report, grants list, financial statements, and lists of board members and staff

Why Not the Best? Results From a National Scorecard on U.S. Health System Performance

Compares the national average healthcare system performance to benchmarks of higher performance. Provides a mechanism for monitoring change over time across goals of health outcomes, quality, access, efficiency, and equity

Automating EHR-Based Reports to Understand Patient Transfers from the Emergency Department to Facilities Outside of a Healthcare System

The electronic health record (EHR) is used in emergency departments to document patient care. Data elements in the EHR can be structured or unstructured. Before the implementation of this project, the reason a patient was transferred from the emergency department (ED) to a facility outside of the WakeMed healthcare system was recorded in an unstructured progress note. Time-consuming manual chart reviews were required to identify why patients were being transferred. The WakeMed executive team sought to understand the reasons for these transfers, to address concerns of patient satisfaction, patient safety, increased healthcare costs, and loss of revenues. The purpose of this quality improvement project was to capture the primary reasons patients are being transferred to facilities outside of the WakeMed system using a structured data field, known as a SmartList, while avoiding increased workflow burden on the ED provider. The data from SmartList was used to update a daily ED transfer report and improve the quality of the report by providing more thorough information about why patients are transferred. This project had a mix of goals (electronic data capture, improved data quality) and challenges (large volume of patients makes it cumbersome to do manual chart reviews). The Data-Information-Knowledge-Wisdom (DIKW) framework was the overall theoretical framework used to guide the project. The Iowa Model of Evidence-Based Practice to Promote Quality Care was used to provide step-by-step guidance to make changes at the organization. The SmartList was added to the EHR for use by ED providers to document the primary transfer reason. A sample of 557 patient ED visits was evaluated after implementation of the new field. A System Usability Scale (SUS) questionnaire was used to assess the ED provider’s perception of the usability of the new data field. The ED providers found the SmartList usable and easy to learn. Members of the executive team at the project site provided positive feedback regarding the updated daily report of transfers from the healthcare system. Using the DIKW framework, we need to take the knowledge gained from projects similar to this and move to wisdom to meet the needs of the patients we serve.Doctor of Nursing Practic

Commonwealth Fund - 2005 Annual Report

Contains mission statement, president's message, program information, grants list, financial statements, project summaries, and list of board members and staff

Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care

Pharmacists’ interventions in minimising medication misadventure in children with cancer

This study evaluated 1741 interventions by clinical pharmacists to reduce medication misadventure in three clinical units of a children’s hospital in Perth, Australia, documented using snapshot self-report and observation. Commonly, pharmacists’ interventions involved taking medication histories, patient counselling and/or drug therapy changes. Active interventions were randomly assessed by an expert panel for their clinical significance. Root cause analysis was used to assess healthcare professionals’ ability to evaluate medication errors causes and formulate preventative strategies

Commonwealth Fund - 2003 Annual Report

Contains mission statement, president's message, program summaries, executive vice president's report, treasurer's report, grants list, financial statements, and lists of board members and staff

Commonwealth Fund - 2006 Annual Report

Contains mission statement, president's message, program information, grants list, financial statements, project summaries, and list of board members and staff

Documentation Of Emergency Department Discharges Against Medical Advice

In investigating information transfer during the discharge against medical advice (AMA) conversation, this research examined the ability of providers to transfer the appropriate quantity and quality of information to allow patients to make an informed decision. Additionally, the research determined an updated rate of AMA discharges. A retrospective chart review was completed utilizing an eight-point screening tool created from policy and literature standards to measure documentation sufficiency over a one-year time interval. Data analysis indicated that healthcare providers documented medico-legal standards the following percentages of the time: (1) capacity (22.0%); (2) agreement of the signs and symptoms determined by documentation of the diagnosis (33.0%); (3) the extent and limitation (8.1%) of the evaluation; (4) documentation of the current treatment plan, risks, and benefits (3.8%); (5) risks and benefits (4.8%) of foregoing treatment; (6) alternatives to suggested treatment (5.7%); (7) an explicit statement the patient left AMA as well as stating what the patient was refusing (50.7%); and, (8) follow-up care including discharge instructions (67.5%). An AMA discharge rate was calculated to be 0.52%. These results show that physicians are not conducting AMA encounters according to quality and safety domains set by oversight institutions and federal requirements. The calculated discharge AMA rate is lower than published studies suggesting the need to standardize the definition of AMA. Future interventions should standardize the discharge procedure with emphasis on provider education to increase safety and quality of care

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement